I. Introduction

Excuse me, my friend Hetty is here. How are you? Fine Good. This is my friend I was just talking about. I’d like for you all to meet my friend, Hetty. I met her at a workshop for Deaf women. The topic of the workshop was cervical cancer and Hetty presented it in ASL. As you already know, I survived cervical cancer. I had no idea what cervical cancer was when my doctor informed me that I had it. Later, I attended this workshop on cervical cancer and I was surprised at how much I learned. Fortunately, I regularly went to my doctor for annual physical check-ups, therefore, my cervical cancer was detected early. Now I’m 100% cured. Hetty will now share important information that may help to save your lives, the way mine was saved. As Deaf women, we all know it is especially difficult for Deaf and Hard of Hearing women to get the health information that we need. Today I want to share important information about cervical cancer with you. I hope this information will be helpful for you in the future.

II. Overview

That’s a good question. Please feel free to ask any questions you may have.

Let me explain what cancer is. Cancer is a disease of cells in your body that become abnormal. Your body contains trillions of cells. Cells are like building blocks for your body. For example, cells group together to make your heart, your eyes, your brain and your lungs. Normal cells within your body do not create any problems. Your body makes new cells when one cell makes identical copies of itself. Sometimes a cell makes a mistake when it copies itself and produces a damaged cell. These damaged cells can divide quickly and create a group of damaged cells called a tumor. Sometimes those damaged cells or tumors will spread throughout the body. If that spread is not controlled, it can lead to death. This occurs because the tumor interferes with normal cell functions.

Is there more than one type of tumor?

Yes. There are two different types of tumors. One is called a benign tumor. It is not cancer, nor is it dangerous, but most of the time this will need to be removed because it can interfere with your body's normal functioning. The second type, the malignant tumor, is dangerous and can spread throughout the body and grow uncontrollably. If allowed to grow, it will cause death. This second type of growth is cancer.

III. Age Related?

I am only 21 years old, so does that mean that I do not have to worry about cancer?

Good question. Hetty, would you be willing to answer that question?

Sure

Thanks

Today we are discussing cancer of the cervix. Specifically metastatic cervical cancer can happen to anyone at any age. Cervical cancer is one cancer that occurs in both younger and older women. It is most common among women who have been or are sexually active. I will now give you information about how to detect cervical cancer early, how to treat it, and save women’s lives. One can prevent cervical cancer by early detection and appropriate treatment. Here are the four topics that we will discuss about cervical cancer:

1) Description, 2) Risk, 3) Detection, and 4) Treatments.

Number 1:

Description of cervical cancer. The cervix is at the top of your vagina and is the bottom portion of the uterus. Your fallopian tubes and ovaries are above the uterus. The cervix has a canal that opens into the vagina. Semen flows into the uterus through the cervix. Menstrual flow exits the uterus through the cervical canal, and babies are also born through the same canal. Cervical cancer happens when a cell in the cervix becomes damaged while it is dividing. It then multiplies and can grow into a cancer tumor that is malignant.

IV. Cause

The exact cause of cervical cancer is unknown. However, a virus is believed to be responsible for most cases of cervical cancer. This virus is called the Human Papillomavirus or HPV. There are at least 80 known varieties of HPV. Only a few actually increase a woman's risk of developing cervical cancer. HPV is spread by sexual contact with an infected partner. Most people with HPV do not have any symptoms.

V. HPV

It is important to know that there are different types of HPV. Some types of HPV can cause wart-like growths in the genital area that rarely lead to cancer. Other types of HPV can infect cells of the cervix and cause them to develop cancer. Even if you become infected with the types of HPV that can cause cancer, it does not mean that you get cancer. It only increases your risk of getting cancer.

VI. At Risk?

Risk of cervical cancer. About 14,000 American women are diagnosed with invasive cervical cancer every year. This cancer grows primarily in the cervix and does spread. About 5,000 American women die from this cancer every year. Deaths from breast and lung cancer are higher in number while deaths from cervical cancer are lower. Cancers such as breast, lung, and colon cancers have a higher fatality rate. However, early detection of cervical cancer keeps the death rate low. This could be different for Deaf and Hard of Hearing women. Perhaps they don’t know how to prevent it.

Cervical cancer usually occurs in women who have been or are sexually active. The risk for this disease is higher in women who have had more than two sexual partners or first had intercourse at an early age because this increases a woman’s risk of getting infected with HPV. If you are African-American or Hispanic-American, or are over the age of 65, you also have a higher chance of getting this disease. Women whose mothers took a hormone called Diethylstilbestrol or DES during their pregnancies also have a greater risk of developing cervical cancer.

Detection of cervical cancer. Early detection of cervical cancer is very important because the treatment options are so effective. HPV, the virus responsible for most cervical cancer, can cause abnormal changes in the cells of your cervix. These abnormal cells can slowly develop into cancer. If these changes are found early, cervical cancer can usually be prevented. Now that scientists know one of the causes of cervical cancer, studies are underway to find ways of preventing these abnormal changes from progressing to cancer. If cervical cancer has already developed, early detection allows more treatment options and a higher chance of cure.

VIII. Symptoms

Most women with early cervical cancer do not experience any warning signs such as pain or abnormal vaginal discharges. As cervical cancer grows, a woman might have abnormal vaginal bleeding such as heavy periods, bleeding in between periods, bleeding after sexual intercourse or bleeding after menopause, or she may experience pain during intercourse. Sometimes by the time a woman notices this bleeding, the cancer has already spread to other parts of the body. This is why your health care provider's screening exams to detect cervical cancer early are so important.

Doctors perform a screening test that can find abnormal cells in the cervix before cancer develops. This test can also diagnose cervical cancer early, when it can be cured. This test is called the Papanicolaou test, also known as the Pap smear.

During the Pap smear test, you will put on a hospital gown and use a sheet to cover yourself during the exam. You will lie down on an examination table and place your feet in stirrups. The doctor will put a speculum into your vagina and look at your cervix. The doctor will then use a narrow brush and a plastic spatula to take a sample of cells from the surface of the cervix and also from inside the opening of the cervix. These cells are then put on a microscope slide. A specialist looks at these cells to see if there are any cancer cells or any abnormal cells that are in danger of becoming cancer cells. A Pap smear causes little discomfort. You should schedule to have your Pap smear when you will not be having your menstrual period.

IX. Screening

No test is 100% perfect, but the Pap smear test is one of the more accurate tests. If done regularly as recommended by your doctor, it increases the chances of detecting abnormal cervical cells and cervical cancer. Every woman should receive a screening exam for cervical cancer. There are certain types of cervical cancer that are not related to sexual activity, so every woman is potentially at risk. If cervical cancer is found, then the patient and doctor will discuss treatment options.

X. Beginning The Process

It is a personal decision to undergo cervical cancer screening, but it is highly recommended for all women. The American Cancer Society and the National Cancer Institute recommend that women begin screening for cervical cancer three years after having sexual intercourse for the first time. For example, if you begin having intercourse at the age of 15, then you should begin screening at the age of 18. Even if you are not sexually active, you should begin your annual screening by the age of 21. Cervical cancer screening involves getting a Pap smear and a pelvic exam every year.

XI. Possible Abnormal Cells Detected

What if my screening test suggests that there may be abnormal cells on my cervix?

It is important to know that not all abnormal cells found on a Pap smear are cancer or will become cancer. In order to find out if the abnormal cells are cancer or in danger of becoming cancer, the doctor may use a special microscope called a colposcope to look at the cervix. The doctor will examine the cervix under the microscope and possibly take a biopsy of any suspicious cells. This procedure is called a colposcopy.

The colposcopy enables the doctor to take a biopsy of the suspicious cells. He will place those cells under the colposcope for examination.

During this procedure, some people have cramping pain. Some women may also have light vaginal discharge for a couple of days following this procedure.

XII. What Happens Next?

If the sample from my cervix shows that there are abnormal cells that are not yet cancer, but are in danger of becoming cancer, what happens next?

Hetty?

Number 4:

Treatments. Cervical cancer is a very curable form of cancer in most cases. The possible treatments for abnormal cervical cells that are not yet cancer are:

…LEEP, conization, cryosurgery, watchful waiting.

You and your doctor will discuss your treatment options. The type and amount of abnormal cell changes, your age, your general health, your desire to have children, and the possible side effects of the treatments will all influence the best treatment options for you.

In some cases, the doctor may suggest removing only a small portion of the cervix. This is called “loop electrosurgical excision procedure,” or LEEP. This is an outpatient procedure in which the diseased tissue is removed from the cervix. This treatment is used when the abnormal changes in your cervix do not reach deep into the cervical tissue. In this procedure, the doctor will insert a speculum into your vagina in order to see the cervix. The doctor will then numb the cervix so you feel no pain. A loop-shaped wire is then used to remove the abnormal tissue from you cervix. The benefits of this procedure are that it requires only one office visit and high cure rates are seen with just one treatment. Women can still have children after undergoing a LEEP procedure. Temporary side effects are cramping and vaginal discharge.

XIII. What is conization?

Conization is similar to a LEEP procedure. It is a small surgical procedure that removes an abnormal area from the cervix. Conization is done in the operating room. Anesthesia is used to put the patient to sleep so she feels no discomfort. The benefits of this treatment are that you can still have children after having this procedure. The risks are bleeding, infection and the risks of receiving anesthesia. Side effects include vomiting, cramping and vaginal discharge that last for a few days.

Since this procedure does not cure the HPV virus, abnormal cells can develop again in the future. Multiple conizations can cause the cervix to become weak. This happens because the cancer cells are removed from the mouth of the cervix. It is the mouth of the cervix that holds the baby inside the uterus. If the cervix becomes weakened, your chances for having a miscarriage increase. Therefore, this additional side effect is less problematic for women who have already had their children.

That’s why early detection is so important: it gives women the option of watchful waiting.

Cryosurgery uses very cold temperatures to kill abnormal cells. This procedure is done in your doctor’s office. Your doctor will insert a speculum into your vagina to look at your cervix. A probe will then be used to send a very cold gas to the surface of the cervix to freeze the abnormal cells. The benefits are that you can still have children after this procedure. This procedure is not painful but you may have temporary side effects including cramping and vaginal discharge.

XIV. What do you mean by watchful waiting?

Okay. It depends on your situation. You and your doctor will discuss possible treatments. In certain cases, you and your doctor might decide not to make an immediate treatment decision. The doctor will observe and monitor the abnormal changes in your cervix over months or years. This choice may be offered if the abnormal changes in your cervix have a very low likelihood of becoming cancer. The risk of watchful waiting is the possibility that the abnormal changes may become cancer, spread and become difficult to cure. The benefit of watchful waiting is that you do not have to go through the inconvenience, expense and side effects of treatment. If those abnormal cells continue to appear your doctor will recommend one of the treatments. (Pause)

Some women’s bodies can effectively fight the HPV virus. Therefore, the problem can resolve itself. The patient will still need regular annual Pap Smears, however, to check for future reoccurrence of the virus or abnormal cells. If abnormal cells do appear again, the patient and her doctor will need to reconsider her options for treatment.

XV. What if the abnormal cells from my cervix are found to be cancer?

For cervical cancer, treatment options include surgery, radiation, chemotherapy, or a combination of these treatments. These procedures can sometimes make it impossible to have children. Women who are still hoping to have children should discuss this desire with their physician because that may influence the treatment choices.

In most cases of advanced cervical cancer, the doctor will suggest surgically removing your cervix. This procedure will remove the cancer cells from the body. However, there are short-term and long-term side effects related to this surgery. First, if the cervix is removed, you might not be able to have children. Second, there are always risks to surgery such as infection and bleeding, and risk from receiving anesthesia, the drugs that put you to sleep during surgery. Depending on the size and location of the tumor, surgery may or may not be an option. If surgery is the recommended treatment, be sure to choose a surgeon who specializes in cancer surgery of the female organs.

XVI. What about radiation? How does that work?

Radiation therapy uses very strong X-rays to kill the cancer cells. It can be used as a treatment alone or in combination with other treatments. There are two ways to deliver radiation treatment. First, X-ray beams can be aimed directly at the cervical cancer cells from an external machine.

Secondly, there is another type of radiation that is administered from a machine that is similar to an ultra sound you receive when you are pregnant. This machine has an applicator that gives off radiation and is placed directly into your vagina for several minutes, a number of hours, or even a few days. This releases constant amounts of radiation to kill the cancer cells over a specific period of time.

XVII. Are there side effects from the radiation?

The radiation will still kill some healthy cells in that area of the body. This may cause skin changes such as redness or peeling, vaginal or rectal pain, vaginal narrowing, nausea, loss of appetite, tiredness, feeling the need to urinate more often, diarrhea, and/or softening of your bones. Most of these side effects last only about two weeks after you stop radiation. However, there are long-term side effects. Some women report sexual difficulties and early menopause. You should talk with your doctor if these side effects occur or if the short term side effects last longer than they should.

XVIII. What if the cervical cancer has spread?

When cancer spreads, chemotherapy is usually recommended. Chemotherapy uses drugs in the form of pills or intravenous injections that kill any cells in your body that are dividing quickly. Cancer cells divide rapidly. However, so do some other healthy cells, like those in your mouth, your stomach, your intestines, your bones, and your hair. Therefore, the drugs can also kill healthy cells in these places. When chemotherapy kills these healthy cells, the result can be mouth sores, tiredness, weakness, hair loss, diarrhea, and an upset stomach.

XIX. Clinical Trials

Clinical trials are studies done to find new ways to diagnose and treat cancer and many other diseases. Clinical trials also search for ways to prevent cancer and reduce symptoms. You should keep an open mind about clinical trials. Ask your doctor about any clinical trials that could benefit you. The National Cancer Institute has lots of information about clinical trials. They will help you make an informed treatment decision. The best idea is to stay open to the possibility of clinical trials because they can offer new solutions for you and for other people with similar problems.

Certain clinical trials include cancer-free women as well. For example, this research might include studies about specific foods that prevent the development of abnormal cells, or prevent abnormal cells from becoming cancer cells.

Summary

Well, we hope that this video has answered some of your questions and concerns about cervical cancer. Let us summarize a few important things for you.

Women over the age of 21 and women of any age who are sexually active should talk to their doctor about having yearly Pap smear exams for cervical cancer as well as pelvic exams as part of their doctor visits.

The better you understand cervical cancer, the more power you have to make the right choices for your own body and health. You can call the American Cancer Society and the National Cancer Institute for more information or visit their web sites.

With what you have learned today, you can make a difference for yourself and your community by being informed and by making responsible decisions about cancer screening. We enjoyed sharing this information with you and hope you will share it with many others. Together, we can improve the health of the Deaf and Hard of Hearing community by making sure its members have the most accurate and current information available. Remember, this video was prepared in 2003. New information about cervical cancer is always developing. Check the following sources for the latest information.